Registration Form
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Fill up Form, Click on Explorer File, then Print and Fax it to CERT Coordinator
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Email @
Occupation
Emergency Contact Phone
Is there any pre-existing medical condition you have that you would like the CERT staff
to be aware of? Yes No


Special Skills or Disaster Experience


Phone the CERT Coordinator for your City to confirm your attendance or ask any question.
Buena Park – Aaron France (714) 562-3554 Afrance@buenapark.com
Cypress – Denise Davis (714) 229-6625 Ddavis@ci.cypress.ca.us Fax: (714) 229-8957
La Palma – Raul Morales (714) 690-3386 Rmorales@cityoflapalma.org
Los Alamitos – Bruce McAlpine (562) 431-2255 Bmcalpine@ci.los-alamitos.ca.us
Seal Beach – Todd De Voe (562) 799-4100-1121Tdevoe@ci.seal-beach.ca.us
Westminster – Rebecca Barlow (714) 898-3315 ext:330 Rbarlow@ci.westminster.ca.us